Psychiatric Medications NCLEX Practice Quiz: 75 Questions

Psychiatric Medications NCLEX Practice Quiz: 75 Questions 1. 1. Question Jose is diagnosed with amphetamine psychosis and was admitted to the emergency room. Nurse Ronald would most likely prepare to administer which of the following medication? o A. Librium o B. Valium o C. Ativan o D. Haldol Incorrect Correct Answer: D. Haldol The nurse would prepare to administer an antipsychotic medication such as Haldol to a client experiencing amphetamine psychosis to decrease agitation & psychotic symptoms, including delusions, hallucinations & cognitive impairment. Haloperidol is a first-generation (typical) antipsychotic medication that is used widely around the world. Food and Drug Administration (FDA) approved the use of haloperidol is for schizophrenia, Tourette syndrome (control of tics and vocal utterances in adults and children), hyperactivity (which may present as impulsivity, difficulty maintaining attention, severe aggressivity, mood instability, and frustration intolerance), severe childhood behavioral problems (such as combative, explosive hyperexcitability), intractable hiccups. It is a typical antipsychotic because it works on positive symptoms of schizophrenia, such as hallucinations and delusions. • Option A: Chlordiazepoxide is a long-acting benzodiazepine and is an FDA approved medication for adults with mild-moderate to severe anxiety disorder, preoperative apprehension and anxiety, and withdrawal symptoms of acute alcohol use disorder. It is also FDA approved for pediatric patients greater than six years old for anxiety. Chlordiazepoxide has anti-anxiety, sedative, appetite-stimulating, and weak analgesic actions. • Option B: Diazepam is an anxiolytic benzodiazepine, first patented and marketed in the United States in 1963. It is a fast-acting, long-lasting benzodiazepine commonly used in the treatment of anxiety disorders, as well as alcohol detoxification, acute recurrent seizures, severe muscle spasm, and spasticity associated with neurologic disorders. In the setting of acute alcohol withdrawal, diazepam is useful for symptomatic relief of agitation, tremor, alcoholic hallucinosis, and acute delirium tremens. • Option C: Lorazepam has common use as the sedative and anxiolytic of choice in the inpatient setting owing to its fast (1 to 3 minute) onset of action when administered intravenously. Lorazepam is also one of the few sedative-hypnotics with a relatively clean side effect profile. Lorazepam is FDA approved for short-term (4 months) relief of anxiety symptoms related to anxiety disorders, anxiety-associated insomnia, anesthesia premedication in adults to relieve anxiety, or to produce sedation/amnesia, and treatment of status epilepticus. 2. 2. Question Which of the following liquids would nurse Leng administer to a female client who is intoxicated with phencyclidine (PCP) to hasten excretion of the chemical? • A. Shake • B. Tea • C. Cranberry Juice • D. Grape juice Incorrect Correct Answer: C. Cranberry Juice An acid environment aids in the excretion of PCP. The nurse will definitely give the client with PCP intoxication cranberry juice to acidify the urine to a ph of 5.5 & accelerate excretion. PCP begins to cause symptoms at a dose of 0.05mg/kg, and a dose of 20 mg or more can cause seizures, coma, and death. It is mainly metabolized by the liver, and 10% is excreted in the kidneys. Inhalation (the most common route of administration) and intravenous routes of administration produce symptoms in 2 to 5 minutes. Oral ingestion produces symptoms in 30 to 60 minutes. • Option A: Most patients survive PCP intoxication with supportive care. Airway, breathing, circulation, and hemodynamic monitoring are essential to the care of patients with PCP toxicity. Intubation with ventilatory support may be required for airway protection. Sedation with medication and physical restraints may be required to control agitation, violent behavior, and psychosis due to PCP intoxication. Placing the patient in a calm environment such as a quiet room with the lights dimmed may be helpful. Benzodiazepines are the preferred medication for chemical sedation in patients with PCP toxicity. • Option B: Patients with mild symptoms can be discharged one to 2 hours after they become symptom-free and have no other medical complications or behavioral issues that need to be addressed. Patients with severe symptoms or medical complications should be admitted to a monitored bed. Patients who are asymptomatic who present to the emergency department after PCP use should be observed for at least 6 hours before being discharged. • Option D: PCP is available as a powder, crystal, liquid, and tablet. It produces both stimulation and depression of the CNS. PCP is a non-competitive antagonist to the NMDA receptor, which causes analgesia, anesthesia, cognitive defects, and psychosis. PCP blocks the uptake of dopamine and norepinephrine, leading to sympathomimetic effects such as hypertension, tachycardia, bronchodilation, and agitation. PCP can also cause sedation, muscarinic, and nicotinic signs by binding to acetylcholine receptors and GABA receptors. Sigma receptor stimulation by PCP causes lethargy and coma. 3. 3. Question When developing a plan of care for a female client with acute stress disorder who lost her sister in a car accident. Which of the following would the nurse expect to initiate? • A. Facilitating progressive review of the accident and its consequences. • B. Postponing discussion of the accident until the client brings it up. • C. Telling the client to avoid details of the accident. • D. Helping the client to evaluate her sister’s behavior. Incorrect Correct Answer: A. Facilitating progressive review of the accident and its consequences The nurse would facilitate progressive review of the accident and its consequence to help the client integrate feelings & memories and to begin the grieving process. Help patients reframe any destructive cognitions (eg, beliefs that they acted terribly and are terrible people or are weak for being so distraught, that life is hopeless or worthless, or that the world is totally unsafe). • Option B: Support self-esteem; help patients understand that their reaction to the trauma is a normal reaction to an abnormal situation, not a sign of weakness or psychopathology. Reassure and help survivors concerning immediate needs, such as rest, food, shelter, social support, or a sense of belonging to a community (some feel cut off and detached). • Option C: Promote coping mechanisms. Avoid prompting discussion of issues that cannot be resolved; avoid abreaction in groups and the resulting contagion effect; respect defenses, and do not force reality on people who cannot handle it yet; keep in mind that debriefing may be harmful. Discuss the experience with patients who want to talk about it, and avoid pressuring those who do not wish to discuss it. • Option D: Check to see if children feel that they somehow caused the death or disaster or if they have other misunderstandings, and take pains to reassure them or correct any misunderstanding; do not assume children are fine just because they are not saying anything. Let them know it is all right to talk about unpleasant feelings (including sadness and anger) and listen to them; sharing personal feelings of sadness with them is all right as well. 4. 4. Question The nursing assistant tells nurse Ronald that the client is not in the dining room for lunch. Nurse Ronald would direct the nursing assistant to do which of the following? • A. Tell the client he’ll need to wait until supper to eat if he misses lunch. • B. Invite the client to lunch and accompany him to the dining room. • C. Inform the client that he has 10 minutes to get to the dining room for lunch. • D. Take the client a lunch tray and let the client eat in his room. Incorrect Correct Answer: B. Invite the client to lunch and accompany him to the dining room. The nurse instructs the nursing assistant to invite the client to lunch & accompany him to the dining room to decrease manipulation, secondary gain, dependency and reinforcement of negative behavior while maintaining the client’s worth. Staff working with manipulative patients are best prepared when they establish firm rules that are rigidly interpreted and consistently enforced among all members of the health care team. Frequent discussions regarding the patient’s progress can help reduce staff frustration and isolation and minimize the patient’s attempts at staff splitting. • Option A: Discussing realistic